Estimación pronóstica para los residentes de clínicas de reposo con demencia avanzada.
(Estimating prognosis for nursing home residents with advanced dementia.)
FUENTE: JAMA. 2004 JUN;291(22):2734-2740.
Susan L. Mitchell; Dan K. Kiely; Mary Beth Hamel; Pil S. Park; John N. Morris; Brant E. Fries.
[artículo original] [14/6/2004]
Resumen
[texto completo en inglés] [traducir]
La supervivencia varía para los pacientes con demencia avanzada, y las herramientas pronósticas exactas no se han desarrollado. Una proporción pequeña de pacientes admitidos a las residencias de ancianos tienen demencia, en parte debido a la dificultad para predecir la supervivencia.
Los autores del estudio, publicado en la revista “JAMA” utilizaron los datos de más de 4.000 pacientes con demencia avanzada para identificar los factores asociados con la mortalidad a los 6 meses y crear una escala para predecir la mortalidad en estos pacientes.
El modelo final incluyó 12 variables, con una puntuación máxima total de 19 puntos. Los pacientes con 12 o más puntos tuvieron una mortalidad del 70% en la cohorte de validación.
Un marcador de riesgo basado en 12 variables de la escala estimó la mortalidad en seis meses para los residentes de clínicas de reposo con demencia avanzada con una mayor exactitud que las pautas pronósticas existentes.
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Abstract
Survival varies for patients with advanced dementia, and accurate prognostic tools have not been developed. A small proportion of patients admitted to hospice have dementia, in part because of the difficulty in predicting survival.
To identify factors associated with 6-month mortality in newly admitted nursing home residents with advanced dementia and to create a practical risk score to predict 6-month mortality in this population.
This was a retrospective cohort study of data from the Minimum Data Set (MDS). All Medicare or Medicaid licensed nursing homes in New York and Michigan were included. Participants had advanced dementia and were admitted to New York nursing homes between June 1, 1994, and December 30, 1998 (derivation cohort, n = 6799), and to Michigan nursing homes from October 1, 1998, through July 30, 2000 (validation cohort, n = 4631).
MDS factors associated with 6-month mortality were determined in the derivation group, and the resulting mortality risk score was evaluated in the validation cohort. Risk score performance was compared with the cut point of 7c on the Functional Assessment Staging (FAST) scale.
Among residents with advanced dementia, 28.3% (n = 1922) died within 6 months of nursing home admission in the derivation cohort; 35.1% (n = 1626) died in the validation cohort. The 6-month mortality rate increased across risk scores (possible range, 0-19): 0 points, 8.9% mortality; 1 to 2, 10.8%; 3 to 5, 23.2%; 6 to 8, 40.4%; 9 to 11, 57.0%; and at least 12, 70.0% in the validation cohort. The area under the receiver operating characteristic (AUROC) curve for predicting 6-month mortality was 0.74 and 0.70 in the derivation and validation cohorts, respectively. Our risk score demonstrated better discrimination to predict 6-month mortality (AUROC, 0.64 for a cutoff of 6 points vs 0.51 for FAST stage 7c).
A risk score based on 12 variables from the MDS estimates 6-month mortality for nursing home residents with advanced dementia with greater accuracy than existing prognostic guidelines.
